Vol 6, No 1 (2012)

Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs) from Pub Med database, as well as domestic literature were used.

Aim — to estimate endothelium lesion, quantity and thrombocyte aggregation function correlation in viral chronic hepatitis C (CHC) and hepatic cirrhosis (HC).

Materials and methods. 50 CHC patients and 28 HC patients were examined. Using IFA method the total nitric oxide, endothelin‑1, vasculoendothelial growth factor levels, Willebrand factor (vWF) activity were investigated, blood plasma desquamated endotheliocyte (DEC) 
number was calculated with Hladovec method, 1978, thrombocyte aggregation (TA) with ADP, collagen, ristocetine was determined.

Results. DEC and vWF demonstrated correlation in CHC (p = 0.014) and HC (p = 0.000004). In HC patients reliable correlation of all the investigated indices of endothelium lesion with the thrombocyte number and TA was detected, but in CHC patients no correlations were revealed. Thus, significant elevation of TA with ristocetine was noted only in CHC. Decrease in thrombocyte amount among CHC patients and,
especially in HC, and heightened vWF activity could change true TA indices. The corrected TA, whose indices in hepatic diseases significantly
increased, was calculated taking into account the correction factor vWF / thrombocytes that in CHC did not differ from that of healthy patients and in HC was essentially higher.

Conclusion. Endothelium dysfunction markers in CH and HC demonstrate correlation with thrombocyte reduction and TA elevation. Determination
of corrected TA permits to reveal disturbances of thrombocyte hemostasis in the form of elevated aggregation in all CHC and HC patients.

Aim — to study clinical and social characteristics of the patients with rheumatoid arthritis in correlation with adherence to basic antinflammatory drugs treatment.

Materials and methods. The study included 154 patients with definite criteria of rheumatoid arthritis by classification of the American College
of Rheumatology (1987) observed in the rheumatology department of the Republican Clinical Hospital and Municipal Clinical Hospital № 7 (Kazan). All patients underwent clinical, radiological and laboratory tests. All patients completes of social-hygiene questionnaire and a questionnaire Health Assessment Questionnaire.

Results. The majority (n = 101, 65.6%)of the patients with RA, adherent to treatment , had less pain intensity by visual analog scale, less severe radiographic changes, better functional status (p < 0,05). Among adherent patients those with longer history of disease (p < 0.05) dominated. Age, sex, educational level, social status, marital status were not correlated with adherence to basic treatment.

Conclusion. The results showed low adherence to treatment of DMARDs in RA patients (65.6%). Adherence was correlated with disease duration, intensity of their pain, functional status, radiological stage of RA (p < 0.05).

Aim — to identify clinical features of streptococcal tonzillofaringitis (TF) using the scale of Centor, provide clinical and laboratory characteristics
of its outcomes to choose optimal antibiotic therapy.

Materials and methods. The study included 386 patients with HF (183 men and 203 women). Scale Centor, bacteriological and immunological
methods were use to identify levels of antibodies to streptolysin O, polysaccharide A, glucuronic acid, dezoksiribonukleinaze B d.

Results. All patients with HF were divided into groups with suspected viral and streptococcal etiology using Centor scale. By the result of complex bacteriological and immunological diagnosis of 13.5 % of patients with HF in the group with suspected viral etiology were moved into the group with streptococcal etiology. For this group as for group with suspected streptococcal etiology systemic antibiotic therapy was recommended.

Conclusion. To complete the question about use of the antibiotic therapy in patients with TF clinical and laboratory examination should be a complete, including the use of the Centor scale. For patients with diagnosed streptococcal etiology of TF dispensary observation and primary prevention of rheumatic fever are required.

Aim — to assess survival of patients with dilated cardiomyopathy (DCM) in 3‑year follow-up based on clinical history, clinical symptoms, indicators of instrumental methods of examination and tactics of the patients.

Materials and methods. 105 patients with diagnosed cardiomyopathy were included in prospective single-center study. Follow‑up period was 3 years or until achieving primary endpoint. Complaints were collected, general clinical research, 6-minute walk test, electrocardiography in 12‑lead were performed annually. Also scale of evaluation of clinical status in patients with chronic heart failure (CHF) in the modification of V.Y. Mareev and assessment of adherence were used annualy.

Results. The group of patients with DCM was represented primarily by man, severe heart failure (III–IV functional class) was originally diagnosed in almost 80 % of patients. During the 3 years of follow-up progression of heart failure, worsening of hemodynamic indices were identified in survivors. When evaluating recommended therapy with found that it meets the current guidelines of treatment of heart failure,
however, low adherence to treatment of patients was revealed with statistically significant difference between groups of survivors and deceased patients. The annual mortality rate was 20 % and had no significant fluctuations. The main cause of death was heart failure decompensation.

Conclusion. Progression of CHF in patients with DCM was confirmed .The most reliable method of assessing the progressive course of heart failure is 6‑minute walk test. The annual high mortality (20 %) indicates an extremely poor prognosis for this disease. The major causes of death were progression of heart failure and sudden cardiac death.

Treatment of chronic heart failure (CHF) often can be a rather difficult task. Proper selection of therapy and strict adherence to the recommendations is vital in these patients. Unfortunately, in practice we often encounter with free interpretation of the recommendations, which leads to tactical errors and reduce the effectiveness of treatment. This article deals with the most common tactical errors, and contains recommendations for the management of patients with CHF, which can be very useful to the practitioner.

Two clinical cases of pulmonary Langerhans cell histiocytosis X have been analyzed demonstrating lung and other inner organ pathology, common clinical and X-ray features but different life prognosis.

It is believed that the concentration of C‑reactive protein (CRP) significantly increases in acute forms of systemic lupus erythematosus (SLE). A moderate increase of CRP levels in patients with stable disease progression reflects the low‑grade chronic inflammation in the vascular wall and the development of subclinical atherosclerosis. The article presents data showing that increased CRP levels in SLE patients is not statistically related with disease activity and cardiovascular risk as well as the level of interleykin‑6. Patients with lupus nephritis have lower CRP concentration compared to patients without renal disease and CRP concentration depends on proteinuria and hypoalbuminemia.

Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.